Molina Medical Group of Michigan, PC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

23D0367347 Issued in MI

Legal business name

MOLINA MEDICAL GROUP OF MICHIGAN, PC

Practice address

4700 Schaefer Rd
Dearborn, MI 48126-3655

Phone

(313) 581-2600

Fax

(313) 581-0228

NPI assigned

Oct 10, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gloria Calderon

Title

VP, Clinic Operations

Phone

(562) 499-6191

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477008000000",
    "number": "1316497761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OCEANGATE",
            "address_2": "SUITE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024317",
            "telephone_number": "562-499-6191",
            "fax_number": "562-499-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 SCHAEFER RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263655",
            "telephone_number": "313-581-2600",
            "fax_number": "313-581-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLINA MEDICAL GROUP OF MICHIGAN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-10-21",
        "status": "A",
        "authorized_official_last_name": "CALDERON",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "VP, CLINIC OPERATIONS",
        "authorized_official_telephone_number": "562-499-6191"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MI",
            "license": "23D0367347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sana Mohsin
• Sarah Ameen Mohsin
• Nicole Mokanyk, LPTA
• Maya Mokh
• Nadine Mokh
• Molina Medical Group of Michigan, PC
• Molina Medical Group of Michigan, PC
• Angelina Christina Molinaro
• Hunter Molino
• Momba Home Care Michigan, LLC

• Clinical Medical Laboratory in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.